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Renovascular Hypertension

Secondary hypertension caused by stenosis of the renal artery and renin-angiotensin activation.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Renovascular Hypertension?

Renovascular hypertension is secondary hypertension that develops when stenosis or occlusion of one or both renal arteries reduces renal perfusion and triggers the renin-angiotensin-aldosterone system. The two main causes are atherosclerotic renal artery stenosis in older adults and fibromuscular dysplasia in younger women.

Clinical clues include onset of severe hypertension before age 30 or after age 55, sudden worsening of previously well-controlled hypertension, resistant hypertension on three or more antihypertensives, recurrent flash pulmonary edema, and unexplained azotemia after starting an ACE inhibitor or ARB.

Screening is performed with renal artery Doppler ultrasound, CT angiography or MR angiography. Catheter angiography remains the gold standard and is used when intervention is planned. Treatment combines aggressive medical therapy (RAAS blockade, statins, antiplatelet) with selective percutaneous angioplasty or stenting in patients with refractory hypertension, progressive renal dysfunction, or recurrent heart failure.

Symptoms

Resistant or accelerated hypertension
Flash pulmonary edema
Abdominal bruit
Worsening renal function on ACEi/ARB
Asymmetric kidney size on imaging
Hypokalemia from secondary hyperaldosteronism
Severe headache and retinopathy

Risk Factors

Atherosclerosis and aging
Smoking
Diabetes mellitus
Dyslipidemia
Female sex (fibromuscular dysplasia)
Coronary or peripheral artery disease
Chronic kidney disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Hypertension before age 30 or after age 55
  • Blood pressure uncontrolled on 3 drugs
  • Sudden creatinine rise after RAAS blocker
  • Recurrent unexplained pulmonary edema
  • New abdominal bruit on examination

Treatment Methods

01
ACE inhibitors or ARBs as first-line drug therapy
02
Calcium channel blockers and diuretics adjuncts
03
Statins and antiplatelet therapy for atherosclerotic disease
04
Smoking cessation and risk-factor optimization
05
Percutaneous angioplasty for fibromuscular dysplasia
06
Renal artery stenting in refractory or unstable patients
07
Surgical revascularization in complex anatomy

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.